Abdominal cramping and heavy vaginal bleeding with passage of large clots

Medicoman · January 26, 2020, 1:02am

22-year-old woman comes to the emergency department due to 4 hours of severe lower abdominal cramping and heavy vaginal

bleeding with passage of large clots. The patient’s pain subsided after the passage of a round, pale mass while she was at home.

Her bleeding currently is as heavy as a normal period and she reports some mild lower abdominal discomfort. She has no fevers,

chills, or abnormal vaginal discharge. Her last menstrual period was 7 weeks ago The patient has a history of intermittent cocaine

abuse and smokes a pack of cigarettes daily. Temperature is 37 C (98.7 F), blood pressure is 120/70 mm Hg, pulse is 90/min, and

respirations are 16/min. Abdominal examination shows mild tenderness over bilateral lower quadrants but no palpable masses or

rigidity. Pelvic examination shows a closed cervix and a small amount of blood pooled in the vaginal vault. Urine 􀁫-hCG is positive.

Transvaginal ultrasound reveals a normal uterus with an empty endometrial cavity, no adnexal masses, and scant free fluid in the

posterior cul-de-sac. Which of the following is the most likely diagnosis?

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